We had an unusal occurance last week in the OR. Our anesthesologist had preformed the pre-op and put the pt under. A fire broke out in the OR. The pt had to be awakened. Can the anesthesologist bill? He would normally bill the anestheisa code with a modifier 52. We found a Medicare policy that says we should not be billing because the surgery was not cancelled due to pt condition. But for hospital problem. The doctor feels he should be able to. Who is correct?

We bill for all cases cancelled after induction. I have gone through yearly external audits for over 10 years and have not had a single auditor who has had an issue with our cancelled case charges. Incidently, I do NOT bill the -52 modifier as all aspects of an anesthesia service have been performed. I do bill the appropriate V64.x code to inform the payer of the cancelled/discontinued surgical procedure.

I would be interested in seeing the Medicare policy you found stating this your case is not billable. Please attach to link.

I am very sorry. I thought someone in our office had found a policy about billing and incidents that happen in the OR. I was wrong on that account.

I really appricate your response. But what about if the surgery is done completely 5 hours later. Would we still be billing for the pre-op again? This surgery was not stopped due to a patient problem. Should would bill time only?

If the provider completed all required elements for BOTH services (separate and distinct documentation of each service, including separate pre-anesthesia evaluation) then I would bill two separate cases. You would need to modifier the lesser charge amount case with the -59 or -76 modifier depending on the payer.

If the provider re-cycled any part of the documentation of the first service to perform second service then I would, most likely, bill it as one case with discontinuous time.

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